17D0875523 CLIA NUMBER - KICKAPOO NATION HEALTH CENTER LAB

Laboratory Demographics

CLIA Code: 17D0875523
Facility Name: KICKAPOO NATION HEALTH CENTER LAB
Facility Address: 1117 GOLDFINCH ROAD
HORTON, KS
ZIP 66439
Facility Phone: 785 915-9751
Facility Type: Federally Qualified Health Center
Facility Type: Waiver
Lab Director: KRISSY L. TORKELSON
NPI Number: 1801058748
Taxonomy: 332800000X - Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy

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CLIA Record

Field Name	Field Value
CLIA Number	17D0875523
LAB Type	Federally Qualified Health Center
Facility Name	KICKAPOO NATION HEALTH CENTER LAB
Street	1117 GOLDFINCH ROAD
City	HORTON
State	KS
ZIP	66439
Phone	785 915-9751
Certificate Type	Certificate of Waiver
Certificate Type Description	This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date	1/7/2025
Certificate Expiration Date	1/6/2027
Facility Type	Federally Qualified Health Center
Lab Director	KRISSY L. TORKELSON

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This page was last updated on: 9/29/2025